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on habit and the real calcium minimum is unknown. Wedo not know whether the ideal calcium intake is one whichfills the reservoirs to overflowing, or one which keeps themempty, or half full. We do not know whether the safetycalcium margin does good or harm, nor do we know theamount needed for this purpose. We do not even knowhow much calcium an individual will get if and when thefortified loaf materialises ; for some people eat twentytimes more bread than others and therefore will gettwenty times more calcium. This kind of laboratorywork is wild speculation of no real scientific value. Butthere is a simple clinical test which gives more reliableinformation than all the laboratory investigations puttogether. It is impossible for a person to remain in anegative calcium balance permanently without exhibitingdefinite evidence of calcium deficiency such as is found incases of osteomalacia. It is certain that the whole adultpopulation who do not exhibit definite evidence of calciumdeficiency are in calcium balance and cannot be sufferersfrom calcium deficiency. The only relevance of ourexperimental work to the Government proposals is thefigures which give requirement values. You yourselfpoint out that these figures are corroborated by Shermanand others. Why then have we been attacked so fiercelyfrom all sides ? The people interested in the Governmentproposals believe that in discrediting us they are

strengthening their own position. This is wrong.The onus of proving their case rests with the reformers.They must prove that there is a calcium deficiency in theadult population, and also that the extra calcium cannotdo harm. They must prove this conclusively, formillions of human beings cannot be used as experimentalrabbits. If our reformers have evidence that there is acalcium deficiency among a considerable section of theadult population, let them publish it. If such evidencedoes not exist, then the attempt to force these proposalson the public is not justified. There is a vital necessityfor a scientific advisory council at the Ministry of Food.I suggest that the Government proposals remain in astate of latency until such a body is created and is ableto review these suggestions.

I. HARRIS.

TREATMENT OF HYPERTOXIC DIPHTHERIA

SIR,-The letter from Dr. J. W. Trevan in your issueof March 8 calls for some comment. Before Dr. Mc-Sweeney used the sera I tested them in my laboratory inorder to form an opinion as to their probable value intreatment. I found that the first serum used gave adilution ratio of 1-2 and was decidedly more avid thanany antitoxin which I had previously tested. I predictedto the Medical Research Council of Ireland and to Dr.McSweeney before he used the serum that it might beexpected to have a therapeutic efficacy at least 50%greater than ordinary antitoxin. The control serum Ifound to have a dilution ratio of 1-0, the same as for arandom sample of refined antitoxin as sold for thera-peutic use. Again before the control serum was used Ipredicted that it would be found to be little differentfrom ordinary antitoxin. Events proved both forecastscorrect except that I rather underestimated the thera-peutic potency of the avid antitoxin. You will see,however, that in my work I have successfully followedthe proper scientific method of hypothesis, based onexperimental observation, followed by prediction andfinally confirmatory trial.Concerning the precautions taken by manufacturers

prior to the issue of new types of sera, the differencebetween Dr. Trevan’s approach to the problem and minewould appear to be that, whereas I regard improvementin therapeutic efficiency as the primary criterion by whichan advance is to be judged, he gives priority to technicalor laboratory improvements and regards clinical trialmerely as an ancillary procedure to exclude the possi-bility of harm being done. Clinical trial is thus to beused in a negative way. He does not tell us incidentallyhow many distinct batches of serum were tested on the570 cases before the present avalanche of refined serabegan, nor does he suggest that any clinical trials wereperformed before Ehrlich’s method of testing was

abandoned in favour of Romer’s.In conclusion, lest the essential aim of my work be

submerged in controversy, may I once more emphasisethat it is my object to restore for the benefit of humanity

the type of diphtheria antitoxin used by the pioneers,which, in doses of a few hundred or thousand units, waseffective in the treatment of the toxaemia of diphtheria.This appears to me to be an aim with which no scientific-ally minded person can quarrel, and towards the attainsment of which not a few will help.

R. A. Q. O’MEARA.

THE PSYCHOPATHIC TENTH

SIR,-In his article of March 8, Dr. Stephen Taylorposes the dilemma of the philosophically minded doctor.His solution is a wholesale determinism which he derivesfrom the results of psychiatric research. From thisposition he develops a classification- of psychopathicand psychotic states on the basis of social criteria and(inevitably) reaches a somewhat nihilistic attitude totherapy. On rational grounds one is bound to agreewith many of his observations, and the psychiatristexperienced in social work will appreciate the practicalvalue of his classification. I would suggest, however,that the sequence of assumptions is based on a fallacy-namely, that the results of research into the humanmind represent a sufficiently comprehensive appreciationof the truth to justify the drawing of final conclusions.Research achieves no more than the abstraction of cer-tain aspects of the truth ; and the methods employed,by their very nature, leave untouched a large field ofmental activity, which can only be expressed in terms ofart (including the art of living) and religion. It may beguessed, from Dr. Taylor’s remark about the continuousbattle with fate, that he is aware of this side of thepicture. In accordance with scientific thought, however,he plumps for the way which is more comprehensible torational consciousness. Psychiatrists might, with advan-tage, shift their position in relation to research in orderthat it may come to occupy a place which allows a viewof the less measurable aspects of mental life. The innerimagination of the truth reached through the interactionof individual sensibilities may reveal the essence -of lifein a way that can never be achieved by research. If thisis accepted, the therapeutic nihilism which, paradoxicallyenough, has followed the adoption of an exclusivelyscientific position may justly be tempered by the idea ofadvance through individual regeneration.

R. G. McINNES.

"CLINICAL ROENTGENOLOGY OF THEALIMENTARY TRACT"

SiR,—In a review of my book (Lancet, Oct. 19, 1940,p. 490) it is stated that I do not mention the importanceof a flat film in the diagnosis of acute intestinal obstruc-tion. Quite the contrary happens to be the fact. Theimportance of the flat film in obstruction of the smallintestine is strongly emphasised in chap. 34 and is illus-trated by figs. 282, 283, 284, and 287. Moreover, I refer tothe value of the flat plate in obstruction of the colon (seefigs. 320 and 403). Another statement to which I takeexception is that the subject of the double contrast enemais barely mentioned. Reference to the text in chap. 37will indicate that not only is the importance of theaerogram emphasised, but a drawing is included of theapparatus employed accompanied by detailed instruc-tions regarding the technical process of such examination.May I also refer you to figs. 309 and 310 ? The actualapplication of the aerogram in the diagnosis of colonicpathology is referred to in the discussion of variouslesions of the bowel (references given). It seems to methat the criticisms were made because this material hadbeen overlooked.

JACOB BUCKSTEIN.

*=t* Our review recognised Dr. Buckstein’s skill in thechoice of films to illustrate diagnostic points. Hisemphasis is certainly a little different from ours but weshould regret if the difference had been overstated.-ED. L.

GARGOYLISM BY ANY OTHER NAMESiR,-The mention of my name in association with

" gargoylism " prompts me to give the facts so far as Ibelieve I am concerned. For over a year I had such acase under my care at the Hospital for Sick Chiidren,Great Ormond Street, but in spite of all my clinicalefforts and the help of others I had entirely failed to